MedPAC Offers Doc Payment Fix Solution

The Medicare Payment Advisory Commission (MedPAC) roiled the health care policy waters last week when it rolled out a solution to the physician Medicare payment problem.  MedPAC’s answer would essentially hold primary care docs harmless, implement an 18 percent across the board payment cut to specialists and get an additional $235 billion of cuts coming from the following sectors: pharmaceutical, $75 billion; post-acute care, $49 billion; beneficiaries, $33 billion; hospitals, $26 billion; labs, $21 billion; durable medical equipment, $14 billion; and Medicare Advantage $12 billion.  Click here to see MedPAC’s 13-slide presentation on the issue.
If Congress does nothing, physicians face a 29.5 percent Medicare pay reduction January 1.  A ten-year fix costs $300 billion.  MedPAC’s recommendation to Congress will be finalized at it October meeting.  As you can imagine, MedPAC’s proposal isn’t getting a lot of love across Washington.

Obama Wants More Medicare, Medicaid Cuts

President Obama plans to announce details today of a plan to trim the federal deficit by more than $3 trillion, including $248 billion to Medicare and $72 billion to Medicaid — on top of cuts already made.  Administration officials said that the Medicare cuts would not come from an increase in the Medicare eligibility age.  Click here for a NY Times summary.

Military Retiree Benefits Could See Cuts

Military pensions and health care for active and retired troops now cost the government about $100 billion a year, so there is a concensus emerging about the need to trim them.  Click here for more.


MA Plans To See Premium Drop, Enrollment Increase

Are Medicare managed care plans on their way out?  Not according to federal officials who last week said Medicare Advantage premiums will go down on average by 4 percent next year and that enrollment is projected to go up by 10 percent. CMS was able to use authority provided by the Affordable Care Act to protect beneficiaries from significant increases in costs or cuts in benefits in 2012, leading to average premium declines for the second year in a row: 2012 premiums are projected to be 11.5 percent below 2010 premiums.  Click here to see CMS’ factsheet.

CMS Says MLR Is Causing Premium Decreases 

A top CMS official said last week they are seeing indications that the Medical Loss Ratio provision is causing insurance companies to more carefully evaluate their need for premium increases, slowing the rate of premium growth and, in some cases, decreasing premiums. For example, more than 15,000 Aetna customers in Connecticut will see their health insurance premiums drop by between 5 percent and 19.5 percent due, in part, to the new MLR policy. Consumers will begin receiving rebates in 2012 from plans that did not meet the standard in 2011. Preliminary estimates indicate that up to 9 million Americans could be eligible for rebates starting in 2012 worth up to $1.4 billion. Click here to read the 7-page CMS testimony.

New Health Center Planning Grants Awarded

Health center planning grants were awarded last week to 129 organizations interested in starting community health centers.  At total of $10 million, about $80,000 per grants, was allocated.  Grants are going to entities in 37 states and DC.  Click here to see the list.


HHS Reg Would Give Patients Direct Access to Their Lab Test Results

HHS last week issued a rule that would allow patients direct access to their laboratory test results.  The rule would modify regulations under two statutes that impose restrictions on patient access to lab results. The statutes are the Clinical Laboratory Improvement Amendments (CLIA) of 1988 and the Health Insurance Portability and Accountability Act (HIPAA) of 1996.  There will be a 60-day public comment period on the proposal.


HHS said it wanted to recognize current health reform concepts, such as individuals’ involvement in their own health care, by allowing patients easier access to health information.  Click here to review the proposed rule.

Medicaid “RACs” Coming

The Administration announced a new initiative last week to save $2 billion in Medicaid waste and improper unemployed insurance payments.  Much of the Medicaid crackdown is focused on creating a RAC-like program that has been underway for Medicare for a few years.  Click here to read the announcement.

$3 Billion to Find Alternatives to Nursing Home Care

CMS is encouraging states to put more focus on finding alternatives to nursing home care.  In a letter to states last week, CMS said it will be providing $3 billion in new grants to help states achieve that goal.  Click here to read the three-page CMS letter to states.

Joint Commission Lists Top 405 Hospitals

The Joint Commission last week issued its annual report on hospital quality and safety.  For the first time, it included a list of the 405 top performing hospitals based on evidenced based care protocols that contribute to positive patient outcomes.  Click here to review the list and see the 39-page report.

Heart Attack, Stroke Reduction Program Announced

A new program designed to reduce the number of of heart attacks and strokes over the next five years was launched last week by a public-private partnership group.  “Million Hearts” is directed by a variety of federal agencies including HHS, CDC, FDA and several private groups including the American College of Cardiology, American Heart Association and the YMCA.  Click here for more.

Mobile Medical Apps Investigated

Mobile medical apps are all the technology rage and the FDA is seeking input on how to regulate those apps.  It held a two-day public hearing last week to hear from a variety of interests.  Click here to read more.